Relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine fetal distress

BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that timely interventions can be implemented to safeguard the health and safety of the fetus.AIM To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.METHODS Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups(n=50 each),according to the presence or absence of intrauterine distress.The ultrasound hemodynamic parameters of the uterine artery(UtA),fetal middle cerebral artery(MCA),and umbilical artery(UmA)were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.RESULTS Comparison of ultrasonic hemodynamic parameters,resistance index(RI),pulsatility index(PI),and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity(S/D),revealed higher values of fetal MCA,PI,and S/D of UmA in pregnant women with UtA compared to controls(P<0.05),while there was no difference between the two groups in terms of RI(P<0.05)The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group(66.7%)than in the control group(90.0%),and neonatal weight(2675.5±27.6 g)was lower than in the control group(3117.5±31.2 g).Further,cesarean section rate was higher in the observation group(70.0%)than in the control group(11.7%),and preterm labor rate was higher in the observation group(40.0%)than in the control group(10.0%).The incidence of fetal distress,neonatal growth restriction and neonatal asphyxia were also higher in the observation group(all P<0.05).CONCLUSION Fetal MCA,UmA,and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy,which suggests that clinical attention should be paid to them,and monitoring should be strengthened to provide guidance for clinical intervention.

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.

Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging

BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

Enhancing hippocampal blood flow after cerebral ischemia and vasodilating basilar arteries:in vivo and in vitro neuroprotective effect of antihypertensive DDPH

1-（2,6-Dimethylphenoxy）-2-（3,4-dimethoxyphenylethylamino）-propane hydrochloride （DDPH） is a novel antihypertensive agent based on structural characteristics of mexiletine and verapamine. We investigated the effect of DDPH on vasodilatation and neuroprotection in a rat model of cerebral ischemiain vivo, and a rabbit model of isolated basilar arteriesin vitro. Our results show that DDPH （10 mg/kg） significantly increased hippocampal blood flowin vivo in cerebral ischemic rats, and exerted dose-dependent relaxation of isolated basilar arteries contracted by histamine or KCl in thein vitro rabbit model. DDPH （3 × 10–5 M） also inhibited histamine-stimulated extracellular calcium inlfux and intracellular calcium release. Our ifndings suggest that DDPH has a vasodilative effect bothin vivo andin vitro, which mediates a neuropro-tective effect on ischemic nerve tissue.

Three-Dimensional Cerebral Aneurysm Models for Surgical Simulation and Education—Development of Aneurysm Models with Perforating Arteries and for Application of Fenestrated Clips

We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.

Predicting Acute Mountain Sickness Using Regional Sea-Level Cerebral Blood Flow

Objective To investigate the role of sea-level cerebral blood flow(CBF)in predicting acute mountain sickness(AMS)using three-dimensional pseudo-continuous arterial spin labeling(3D-pCASL).Methods Forty-eight healthy volunteers reached an altitude of 3,650 m by air after undergoing a head magnetic resonance imaging(MRI)including 3D-pCASL at sea level.The CBF values of the bilateral anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),and posterior inferior cerebellar artery(PICA)territories and the laterality index(LI)of CBF were compared between the AMS and non-AMS groups.Statistical analyses were performed to determine the relationship between CBF and AMS,and the predictive performance was assessed using receiver operating characteristic(ROC)curves.Results The mean cortical CBF in women(81.65±2.69 mL/100 g/min)was higher than that in men(74.35±2.12 mL/100 g/min)(P<0.05).In men,the cortical CBF values in the bilateral ACA,PCA,PICA,and right MCA were higher in patients with AMS than in those without.Cortical CBF in the right PCA best predicted AMS(AUC=0.818).In women,the LI of CBF in the ACA was different between the AMS and non-AMS groups and predicted AMS with an AUC of 0.753.Conclusion Although the mechanism and prediction of AMS are quite complicated,higher cortical CBF at sea level,especially the CBF of the posterior circulatory system,may be used for prediction in male volunteers using non-invasive 3D-pCASL.

Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories:A detailed exploration and its clinical implications

Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)circulations.Noninvasive neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and autoregulation.Studies indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular resistance.On the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory capacity.in acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior circulation.Proposed physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(e.g.nitric oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic CA.Improving our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.

Investigation multi-target synergistic mechanism of Choerospondias axillaris in the treat of cerebral ischemia based on systems pharmacology and experimental verification

Background:Choerospondias axillaris(CA)is a traditional Mongolian medicine that has been proven to have a good therapeutic effect on cerebrovascular disease.Cerebral Ischemia(CI)is a severe and life-threatening cerebrovascular disease.However,the specific mechanism of action of CA in the treatment of CI is still unclear.Methods:In this study,the related targets and pathways of CA in the treatment of CI were first predicted by system pharmacology and then verified by relevant experiments.Results:The results showed that 12 active ingredients and 208 targets were selected.Further validation through protein-protein interaction(PPI)network analysis and active ingredients-target-pathway(A-T-P)network analysis has confirmed the pivotal roles of the main bioactive constituents,including quercetin,kaempferol,naringin,β-sitosterol,and gallic acid.These components exert their anti-ischemic effects by modulating key targets such as IL6,TNF,MAPK3,and CASP3,thereby regulating the PI3K-Akt,HIF-1,and MAPK signaling pathways,which are integral to processes like inflammation,apoptosis,and oxidative stress.More importantly,through experimental verification,this study confirmed our prediction that CAE significantly reduced neurological function scores,infarct volume,and the percentage of apoptosis neurons.Conclusion:This indicates that CA acts on CI through multi-target synergistic mechanism,and this study provides theoretical basis for the clinical application of CA.

Cerebral and pulmonary embolisms after transcatheter arterial chemoembolization for hepatocellular carcinoma

A cerebral lipiodol embolism is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma. We present a case of cerebral lipiodol embolism that occurred after the third arterial chemoembolization, report the clinical and radiological findings, and review the medical literature.

Pulmonary and cerebral lipiodol embolism after transcatheter arterial hemoembolization in hepatocellular carcinoma

Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.

Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury

Cerebral blood flow is strongly associated with brain function, and is the main symptom and diagnostic basis for a variety of encephalopathies. However, changes in cerebral blood flow after mild traumatic brain injury remain poorly understood. This study sought to observe changes in cerebral blood flow in different regions after mild traumatic brain injury using pulsed arterial spin labeling. Our results demonstrate maximal cerebral blood flow in gray matter and minimal in the white matter of patients with mild traumatic brain injury. At the acute and subacute stages, cerebral blood flow was reduced in the occipital lobe, parietal lobe, central region, subcutaneous region, and frontal lobe. Cerebral blood flow was restored at the chronic stage. At the acute, subacute, and chronic stages, changes in cerebral blood flow were not apparent in the insula. Cerebral blood flow in the temporal lobe and limbic lobe diminished at the acute and subacute stages, but was restored at the chronic stage. These findings suggest that pulsed arterial spin labeling can precisely measure cerebral blood flow in various brain regions, and may play a reference role in evaluating a patient＇s condition and judging prognosis after traumatic brain injury.

Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia

BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction,especially since the onset of thrombolytic therapy takes 1-6 h.Therefore,early diagnosis and evaluation of cerebral infarction is important.AIM To investigate the diagnostic value of magnetic resonance multi-delay threedimensional arterial spin labeling(3DASL)and diffusion kurtosis imaging(DKI)in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included.All patients in the acute stage underwent magnetic resonance-based examination,and the data were processed by the system’s own software.The apparent diffusion coefficient(ADC),average diffusion coefficient(MD),axial diffusion(AD),radial diffusion(RD),average kurtosis(MK),radial kurtosis(fairly RK),axial kurtosis(AK),and perfusion parameters post-labeling delays(PLD)in the focal area and its corresponding area were compared.The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging(T2WI)was analyzed.RESULTS The DKI parameters of focal and control areas in the study subjects were compared.The ADC,MD,AD,and RD values in the lesion area were significantly lower than those in the control area.The MK,RK,and AK values in the lesion area were significantly higher than those in the control area.The MK/MD value in the infarct lesions was used to determine the matching situation.MK/MD<5 mm was considered matching and MK/MD≥5 mm was considered mismatching.PLD1.5s and PLD2.5s perfusion parameters in the central,peripheral,and control areas of the infarct lesions in MK/MD-matched and-unmatched patients were not significantly different.PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and-unmatched patients were significantly lower than those in peripheral and control areas.The MK and MD maps showed a lesion area of 20.08±5.74 cm^(2) and 22.09±5.58 cm^(2),respectively.T2WI showed a lesion area of 19.76±5.02 cm^(2).There were no significant differences in the cerebral infarction lesion areas measured using the three methods.MK,MD,and T2WI showed a good correlation.CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction.3DASL can effectively determine the changes in perfusion levels in the lesion area.There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Clinical Efficacy of Modified Erchen Decoction on Cervical Spondylotic Vertebral Arteriopathy with Stagnation and Blockade of Phlegm-dampness Syndrome and Effects on Cerebral Blood Flow Parameters

OBJECTIVE: To observe the effect of Modified Erchen Decoction on cervical spondylotic vertebral arteriopathy with stagnation and blockade of phlegm-dampness syndrome and effects on cerebral blood flow parameters. METHODS: A total of 80 cervical spondylotic vertebral arteriopathy(CSA) patients with stagnation and blockade of phlegmdampness syndrome admitted to our hospital from October 2016 to April 2017 were selected and randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with Modified Erchen Decoction and the control group was given conventional treatment with Western medicine. After 4 weeks of treatment, the main clinical symptoms and signs(vertigo, neck and shoulder pain, headache, psychological and social adjustment, daily life and work) and cerebral blood flow parameters [the peak values of intracranial vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp)] were compared between the 2 groups. The total clinical effective rate and adverse reactions during treatment were also compared. RESULTS: After treatment, the total effective rate of the observation group was 90.0%, which was significantly higher than that of the control group(77.5%). The difference between the two groups was statistically significant(P < 0.05). After treatment, The scores of vertigo, neck and shoulder pain, headache, psychology and society adaptation, daily life and work were significantly increased(P < 0.05), and the above scores of the observation group were increased more obviously. The difference between the groups was statistically significant(P < 0.05). After treatment, the levels of Vd and Vp were significantly increased(P < 0.05), and the increase of the above indexes was more obvious in the observation group. The difference between the 2 groups was statistically significant(P < 0.05). There were no significant abnormalities in blood routine, urine routine, liver function and renal function. There was no significant difference in the incidence of adverse reactions between the 2 groups.(P > 0.05). CONCLUSION: The treatment of vertebral artery type cervical spondylopathy with stagnation and blockade of phlegm-dampness syndrome by Modified Erchen Decoction can effectively relieve the main clinical symptoms and signs, improve cerebral blood flow parameters, and improve the peak values of vertebral-basal artery diastolic blood flow velocity(Vd) and systolic blood flow velocity(Vp), which is safe and effective, and helps to promote the recovery of cervical function.

Effects of L-Tetrahydropalmatine on NOSⅢ Gene Expression in Hypoxia and Cultured Porcine Cerebral Arterial Endothelial Cells during Reoxygenation

To investigate the expression of NOSⅢ mRNA and protein in cultured porcine cerebral arterial endothelial cells (CAEC) during hypoxia and reoxygenation and the effects of L-Tetrahydropalmatine (L-THP) on the gene expression of NOSⅢ in CAEC during hypoxia and reoxygenation. The cultured CAEC were divided into 5 groups: control, hypoxia, hypoxia+reoxygenation, hypoxia+L-THP and reoxygenation+L-THP groups. NOSⅢ mRNA expression was detected by reverse transcription-polymerase chain reaction (RT-PCR). Immunocytochemistry was used to detect the level of NOSⅢ protein. The expression of NOSⅢ mRNA and protein were increased when CAEC were exposed to hypoxia for 1 h, and significantly decreased during reoxygenation 2, 6 and 12 h after 1-h of hypoxia. L-THP from 10 -8 mol/L to 10 -3 mol/L could inhibit the up-regulation of NOSⅢ gene expression during hypoxia and down-regulation of NOSⅢ gene expression during reoxygenation.

Computed Tomography Angiography Compared to Catheter Based Angiography in Evaluation of Cerebral Arterial Aneurysm and Arteriovenous Malformation

Both cerebral arterial aneurysm and arteriovenous malformation are cerebrovascular disease, which required immediate diagnosis and urgent treatment. Since the introduction of multislice CT scanners, CT angiography (CTA) has become a powerful tool for imaging the vascular system. The goal of this study is to compare catheter based angiography and CTA in the evaluation of cerebral arterial aneurysm and arteriovenous malformation AVM. A retrospective analysis of 50 patients for exploring the record of patient who underwent both multislice CT angiography (MSCTA) and catheter based angiography before treatment is presented during last one year in the department of Radiology, King Fahd Hospital-Jeddah, Kingdom of Saudi Arabia. The sensitivity of CTA for picking up aneurysm is 86% and the sensitivity of catheter based angiography for picking up aneurysm is 97%. The specificity of CTA for picking up aneurysm is (76%), the false positive cases are (3%) and the false negative cases are 10%. The sensitivity of both CTA and catheter based angiography for picking up arteriovenous malformation is (90%). The specificity of CTA for picking up AVM is (76%), the false positive cases are (10%) and no false negative cases in CTA are found. The sensitivity and specificity of catheter based angiography is 100% in diagnosis and detection of cerebral arterial aneurysm and AVM. The present study concluded that CTA has high sensitivity and specificity in detecting aneurysm and AVM enough to be chosen as the first step. Catheter based angiography, still a gold standard for radiology examination, is the most accurate, sensitive and specific method in diagnosis and detection of cerebral arterial aneurysm and arteriovenous malformation, which can be done as the second step. In addition, catheter based angiography is done for treatment planning, treatment with interventional procedure and for prognosis after treatment.

Relationship of cerebral arterial stenosis to cognitive and memory disorders

BACKGROUND: Cerebral arterial stenosis can cause cerebral hypoperfusion, and than result in the decline of cognitive function, whereas the cognitive dysfunction induced by different cerebral arterial stenosis have different manifestations and types. OBJECTIVE: To observe the differences of cognitive and memory dysfunctions in patients with cerebral arterial stenosis of different types. DESIGN: A comparative observation. SETTING: Affiliated Hospital of Jining Medical College. PARTICIPANTS: Forty-two outpatients or inpatients with cerebral arterial stenosis were selected from the Department of Neurology, Affiliated Hospital of Jining Medical College from February 2005 to January 2006, including 25 males and 17 females. There were 18 cases of internal carotid arterial stenosis, 14 cases of vertebrobasilar arterial stenosis and 10 cases of whole cerebral arterial stenosis. The diagnostic standards for cerebral arterial stenosis were identified according to North American Symptomatic Carotid Endarterectomy Trial (NASCET). Meanwhile, 18 healthy physical examinees were enrolled as the control group, including 10 males and 8 females, aged 58-80 years old. All the enrolled subjects were informed and agreed with the detection and evaluation. METHODS: ① The memory function was evaluated using revised Wechsler memory scale for adults, including long-term memory (experience, orientation and counting), short-term memory (visual recognition, picture memory, visual regeneration, association and thigmesthesia) and sensory memory (forward and backward recitation of numbers). The scale scores were turned to memory quotients. The higher the scores, the better the memory function. ② The cognitive function was evaluated using revised Wechsler adult intelligence scale: It consisted of eleven subtests, including six language scales (information, digit span, vocabulary, arithmetics, apprehension, similarity) and five operation scales (picture completion, picture arrangement, block design, geometric design, digit-symbol test). The intelligence quotients were obtained. The higher the scores, the better the cognitive function. MAIN OUTCOME MEASURES: Results of memory and cognitive function test in patients with cerebral arterial stenosis of different types. RESULTS: All the 42 patients with cerebral artery stenosis and 11 healthy subjects were involved in the final analysis of results. ① Results of memory function test: The memory function was worse in the arterial stensis groups than in the control group (P < 0.05-0.01). There were very significant differences in the scores of orientation, association and picture memory between the internal carotid arterial stenosis group and control group (P < 0.01). There were also very significant differences in the scores of counting, logic memory, forward and backward recitation of numbers, visual regeneration, visual recognition and thigmesthesia between the vertebrobasilar arterial stenosis group and control group (P < 0.01). Except experience and visual regeneration, there were significant very differences in the scores of the other tests between the whole cerebral arterial stenosis group and control group (P < 0.01). The memory quotient was obviously lower in the vertebrobasilar arterial stenosis group than in the internal carotid arterial stenosis group [(72.31±26.46), (87.38±21.86) points, P < 0.05], and it was the lowest in the whole cerebral arterial stenosis group [(63.74±25.25) points]. ② Results of cognitive function test: The cognitive function was worse in the arterial stensis groups than in the control group (P < 0.05-0.01). There were very significant differences in the scores of apprehension, arithmetics, similarity, digit-symbol test, picture completion and block design between the internal carotid arterial stenosis group and control group (P < 0.01). There were also very significant differences in the scores of backward recitation of numbers, vocabulary and geometric design between the vertebrobasilar arterial stenosis group and control group (P < 0.01). Except information, there were significant very differences in the scores of the other tests between the whole cerebral arterial stenosis group and control group (P < 0.01). The intelligence quotient was obviously lower in the internal carotid arterial stenosis group than in the vertebrobasilar arterial stenosis group [(72.65±23.39), (81.34±25.46) points, P < 0.05], and it was the lowest in the whole cerebral arterial stenosis group [(65.98±27.34) points]. CONCLUSION: Different cerebral arterial stenosis can induce different cognitive dysfunctions. The main manifestation of the patients with internal carotid arterial stenosis was the declined cognitive function, and that in patients with vertebrobasilar arterial stenosis was the declined memory, and the decrease of total intelligence was more obvious in the formers than in the latters, whereas the decrease of total memory quotient was more obvious in the patients with vertebrobasilar arterial stenosis; The cognitive and memory dysfunction were the most serious in patients with whole cerebral arterial stenosis.

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index (ABI) is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes mellitus (DM); however, the application in cerebral infarction (CI) is rare. OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease (PAD), compare metabolic characteristics of patients who having CI plus PAD or only having CI, and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb. DESIGN: Contrast observation based on CI patients. SETTING: Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 124 CI patients were selected from Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006, including 72 males and 52 females aged from 45 to 88 years. All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination. All patients provided informed consent. There were 46 cases (37.2%) with CI plus PAD and 78 cases (62.8%) only with CI. METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor (GE Company). The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI. The normal ABI was equal to or more than 0.9. If ABI < 0.9 occurred at one side, patients were diagnosed as PAD. On the second morning after hospitalization, blood was collected to measure fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG2h), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, blood glucose, lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase. Measurement data and enumeration data were compared with t test and Chi-square test, and multiple factors were dealt with Logistic regression analysis and multivariate linear regression analysis. MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis; risk factors of CI plus PAD with Logistic regression analysis; comparisons of metabolic markers between PAD and non-PAD patients. RESULTS: All 124 patients with acute CI were involved in the final analysis. ① Comparisons of metabolic markers: Levels of serum LDL-C and uric acid (UA) were higher of PAD patients than those of non-PAD patients (t =2.051 9, 3.339 1, P < 0.05); however, there were no significant differences among other metabolic markers (P > 0.05). ② Results of multivariate linear regression analysis: PBG2h, LDL-C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery (partial regression coefficient = -0.231 to -1.010, P < 0.05). ③ Risk factors of CI plus PAD with Logistic regression analysis: Age, smoking history, sum of CI focus (≥3) and LDL-C were independent risk factor of CI plus PAD (OR =1.524-5.422, P < 0.05-0.01). CONCLUSION: ① Levels of serum LDL-C and UA of patients with CI plus PAD are high. ② ABI of lower limbs is correlation with PBG2h, LDL-C and UA. In addition, measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose, abnormal lipid and poor renal function. ③ Age, LDL-C and sum of CI focus (≥3) are independent risk factors of CI plus PAD. It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

BACKGROUND: With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovascular stricture is still unclear. OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI). DESIGN: Contrast observation. SETTING: Department of Neurology, the First Hospital of Jilin University. PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent. METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture > 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s, 180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously. MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI. RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 cases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%) with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61.8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21.4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile, TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (χ2 =26.854, P =0.001). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (χ2 =21.258, P =0.001). ⑤ Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture. There were significant differences (χ2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (χ2 =0.597, P =0.440). CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture. ③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.

Different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion

Objective:To study the different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion.Methods: Patients with acute middle cerebral artery occlusion who were treated in the First Hospital of Yulin between September 2013 and October 2017 were selected and retrospectively studied, and the differences in reperfusion therapies in history data were referred to divide them into study group A and study group B who underwent mechanical embolus removal and intra-arterial thrombolysis respectively. The levels of neurocyte damage markers, apoptosis markers and stress markers in serum as well as the expression of Wnt pathway molecules in peripheral blood were determined before treatment and 24 h after treatment.Results: Compared with those of same group before treatment, serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of both groups were decreasing whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were increasing, and serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of study group A after treatment were lower than those of study group B whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were higher than those of study group B.Conclusion: Mechanical embolus removal for acute middle cerebral artery occlusion can be more effective than intra-arterial thrombolysis to reduce the nerve function damage as well as the corresponding oxidative stress and apoptosis.